IM 1 Flashcards
(141 cards)
1
Q
most sensistive in detetcing vit b 12 deficiency
A
MMA
2
Q
middle-aged woman with fatigue, pruritus, hepatomegaly, elevated alk phosp, serum anti-mitochondiral Ab
A
primary biliary cholangitis - give ursodeoxy
3
Q
elevated in paget disease
A
alk phos, PINP and urnine hydroxyproline (ca and ph normal)
4
Q
labs of primary hyperparathyroidism
A
+ ca,, low phosp, + alk phos
5
Q
deep linear ulcers and esophagitis in HIV
A
CMV
6
Q
lymphadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, multiple infections, lymphocytosis, smudge cells, B symptoms
A
CLL, dx with flow cytometry
7
Q
anemia, bone pain, rouleaux formation, leukopnia
A
MM
8
Q
pellagra
A
niacin deficiency: 3 ds: dermatitis, diarrhea, dementia
9
Q
HIV vaccinations
A
Hep B, PCV, variclla (CD4 must be > 200), meningococcal
10
Q
fatigue, painless oral ulcers, arthritis, renal abnormalities, LAD, splenomegaly, thrombocytopenia and anemia
A
SLE
11
Q
tx of preg or lactating mom with lyme’s
A
amoxicillin, avoid teratogenicity of doxy
12
Q
bilateral diffuse interstitial infiltratess
A
PJP
13
Q
abx coverage of aspiration penumonia with anaerobics
A
clindamycin, metronidaolze + amoxicilline, amoxicillin-clavulanate, carbapenem
14
Q
you find hypercalcemia on labs, what is your next step of evaluation?
A
PTH (if suppressed, think malignancy if NOT suppressed, think primary hyperparathyroidism)
15
Q
causes of ATN
A
aminoglycosides, contrast, hypotension - AKI immediately following
16
Q
two common causes of nephrotic syndrome
A
FSGS and membranous nephropathy
17
Q
nephropathy + AA, HIV, heroin use, obesity
A
FSGS
18
Q
leukocytosis, basophlia, shift towards early neutrophil precursor cells, low lukocytes alk phosphatase score (marker of neutrophil activity), BCR-ABL
A
CML
19
Q
pancytopenia, myeloblasts on smear, auer rods
A
ALL
20
Q
multiple ring enhancing lesions, low CD4 count in HIV
A
toxo, sulfadiazine and pyrimethamine
21
Q
type 4 renal tubular acidosis
A
non-AG metabolic acidosis, persistent hyperK, mild-mod renal insufficiency; common in poorly controlled DM
22
Q
acid status in vomiting
A
hypochloremic metabolic alkalosis
23
Q
electrolyte disturbance of primary hyperaldosteronism
A
saves sodium and pushes potassium out (and H+ follows K) = hypernatremia, hypokalemia metabolic alkalosis
24
Q
red flag symptoms for cavernous sinus thrombosis:
A
severe HA, bilateral periorbital edema, cranial nerve III, IV, V, and VI deficits
25
elevated liver transaminases and a + antinuclear antibody titer
autoimmune hepatitis, tx with glucocorticoids
26
causes of gout
increased urate production (myelproliferative disorders, tumor lysis, primary gout, enzyme deficiency)
decreased urate clearance (CKD, diuretics)
27
mgmt of non bleeding esophageal varieces in cirrhotic paient
nonselective bb (propranolol, nadolol)
28
tx of active variceal bleed
octreotide, endoscopic sclerotherapy and banding
29
statistical analysis to compare the means of two groups of subjects
two-sample t test
30
this statistical test is appropriate for categorical data and proporitons
chi-square
31
the two sample t-test is used to compare TWO means, what is used to compare MORE THAN two means?
ANOVA
32
causes of exudative effusions
infection (pneumonia, empyema, tb), malignancy, rheumatologic disease, PE
33
Can RA causes an exudative effusion?
yes
34
causes of transudative effusions?
HF, cirrhosis, nephrotic syndrome
35
lipohyalinosis, microatheroma, HTN, DM, hyperlipidemia, smoking, internal capsule, pure motor hemiparesis
lacunar stroke
36
what must you be quick to suspect in cirrhotic patient
SBP and esophageal varices
37
decreased haptoglobin, increased LDH and bili
hemolytic anemia
38
CAP
s pneumo
39
+ hydrogen breath test, positive stool test for reducing substances, low stool ph and increased stool osmotic gap
lactose intolerance
40
clonal B cell neoplasm, BRAF mutation, pancytogepani, spelnomegaly, dx with BM biops yand flow cytometry
hairy cell leukochemia
41
hyperkalemia EKG findings
peaked T waves, shortened QT interval
PR prolongation, QRS widening
Disappearance of P waves
Conduction blocks, ectopy, sine wave pattern
42
steps of DKA care
NS and regular insulin infusion, serial assessment of electrolytes (esp K) and tx of underlying precipitating factors
43
elevated liver enzymes, DM, skin hyperpigmentation
hereditary hemochromatosis
44
can cholesterol emboli cause livedo reticularis, AKI, pancreatitis and mesenteric ischemia?
yes
45
tx of symptomatic bradycardia
IV atropine
46
two rxs that can be used in BP tx of hyperaldosteronism
eplerenone and spironolactone (want to antagonize effects of aldosterone)
47
it is recommended that pts < 65 with chronic medication cond'n (heart, lung diabetes, smoking, chronic liver disease) revice PPSV23 one dose
yes
48
when to start screening colonoscopy for UC
8 years after dx and every year then after
49
proximal muscle weakness, muscle atrophy + anxiety, tachycardia, weigth loss
acute thyrotoxic myopathy
50
middle-aged women, symmetric proximal muscle weakness and tenderness
polymyositis
51
what is mixed venous oxygen saturation during shock
high as tissues are not able to adequately extract oxygen
52
what is the difference between strawberry and cherry hemangiomas
strawberry = infantile, wherease cherry hemaniomase are common in again adults
53
painful, flaccid bullae, mucosal erosions, separation of epidermis from dermis by light friction, antibodies directed against desmogleins 1 and 3, row of tombstones, IgG and C3 deposits
pemphigus vulgaris
54
why ibuprofen + colchicine for pericarditis tx?
anti-inflammatory and colchicine lowers rate of recurrence
55
inflammatory arthritis + splenomegaly + neutropenai
felty syndrome, associated with RA
56
rx for CMV ppx
ganciclovir or valganciclovir
57
rx for PJP ppx
TMP-SMX
58
diabetes, liver disease, chondrocalcinosis + pseudogout + chronic arthopathy
hereditary hemochromatosis
59
anti-histone Ab
drug induced lupus
60
Anti-Ro (SSA) or Anti-La (SSB)
Sjogren's syndrome
61
Anti-Scl-70, Anti-topoisomerase
systemic sclerosis
62
kid with Acrodermatitis
| enteropathica
zinc deficiency
63
dx and tx of basal cell
Shave or punch bx then surgical removal (Mohs)
64
dx and tx of squamous cell
– Excisional bx at edge of lesion, then wide local excision.
65
dilute urin
urine osmol < 1/2 plasma osmol
66
primary polydipsia vs DI
DI = serum Na > 145 + dilute urine (urine osmol < 1/2 serum)
67
central vs nephrogenic DI
central = decreased ADH; nephrogenic = ADH resistance, commonly 2/2 rx
68
how do vagal nerves slow SVT
slow conduction in AV node
69
is medullary thyroid CA associated with MEN II syndrome (pheo, hypercalcemia)
yes
70
weakness, hypotension, hyperpigmentation, weight loss, hyperkalemia, hyponatremia
primary adrenal insufficiency/addison's disease
71
kidney stones, constipation, new psych sx
hypercalcemia 2/2 hyperparathyroidism (high PTH, vitamin D, and Ca, LOW PO4)
72
MEN 1
pituitary adenoma, parathyroid hyperplasia,
| pancreatic islet cell tumor
73
MEN 2
parathryoid hyperplasia, medullary thyroid cancer,
| pheochromocytoma
74
MEN 3
medullary thyroid cancer, pheochromocytoma,
| Marfanoid
75
EEG with 3 Hz spike-andwave
absence seizures, tx with ethosuxamide
76
EEG with diffuse background slowing
Delirium. Contrast w/ psychosis that has no
| EEG changes
77
EEG with hypsarrhythmia
Infantile spasms. Tx w/ ACTH. Most are
| associated w/ mental retardation.
78
CSF shows albumino-cytologic dissociation, recent GI illness, ascending paralysis + Campylobacter, HHV, CMV, EBV
Guillan Barre, tx with IVIG or plasmapharesis
79
nasal voice, ptosis, dysphagia, respiratory acidosis
MG - check nicotinic receptor anitbodies and if +, get chest CT to evaluate for thymoma; tx with pyridostigmine
80
best test for achalasia
manometry
81
best test for GERD
24 pH monitoring
82
HIV with CD4 < 100 and dysphagia
CMV, HSV, candida
83
mid epigastric pain with multiple ulcers that do not respond to tx
consider zollinger ellison syndrome (gastrin secreting tumor); look for pituitary and parathyroid issues as part of MEN 1
84
chronic mid epigastric pain, steattorhea, DM
chronic pancreatitis
85
bloody diarrhea ddx
EHEC, shigella, vibrio parahaemolyticus, salmonella, entamoeba histolytica
86
pt presents with flushing, tachycardia, hypotension and is dx with carcinoid syndrome. pt is also found to have a skin rash, diarrhea, and memory changes.
pellagra due to niacin consumption in carcinoid syndrome
87
auer rods, myeloperoxidase, esterase
AML
88
9:22 translocation, imatinib, B symptoms, low LAP, basophilia
CML
89
asymptomatic leukocytosis with lymphocyte predominance
CLL
90
enlarged, painless, rubbery LAD
think lymphoma
91
IgM monoclonal spike, hypercalcemia, punched out bone lesions,
MM
92
Blowing diastolic murmur with widened pulse pressure
AR
93
transudative pleural effusion with low glucose
RA
94
transudative pleural effusion with lymphocytes
Tb
95
DLCO is reduced in this restrictive lung disease
ILD
96
DLCO is reduced in this obstructive lung disease
emphysema
97
ptosis improved with looking up, antibody to presynaptic calcium channel, small cell lung cancer
lambert eaton
98
4 syndromes associated with small cell lung cacners
Lambert Eaton (ptosis improved after looking upwards), ACTH (Cushing), SIADH (hyponatremia, HTN), Super sulcus syndrome (pain, ptosis, constricted puil, fascial edema)
99
4 steps of COPD tx
SABA (albuterol), LAMA (ipratropium), LABA (salmeterol), ICS (prednisone)
100
5 types of SSRIs
paroxetine, sertraline, fluoxetine, citalopram, esxitalopram
101
COPD FEV1 for severe
30-50%
102
medial knee pain
pes anserine bursitis
103
posterior knee pain with locking and catching
meniscus
104
pain on tibial tuberosity
osgood schlatter
105
lateral hip pain
greater trochanter bursitis
106
groin, buttock, lateral hip pain worse with exercise
OA hip
107
40-50 y/o F, proximal muscle weakness, unable to climb stairs, weak when lifting hands above head, difficulty chewing and swallowing, labs with + CK, aldolase, AST, ESR, ANA + anti-Jo Ab
for dx, get biopsy (necrotic and referating fibers) . likely POLYMYOSITIS, tx = steroids
108
> 50 y/o F, stiffness in shoulder, hip, neck, + ESR and CRP, associated with GIANT CELL arteritis
polymyalgia rheumatica, tx is glucocorticoids
109
enthesitis, dactylitis, uveitis, aortic valve regurgitation, sacroilitis, restrictive PFTS
AS
110
bilateral hilar adenopathy, hypercalcemia, african amercian, co + dyspnea + skin findings
sacroidosis; tx with steroids
111
pH for acidosis
< 7.35
112
SAVES SODIUM, PUSHES POTASSIUM OUT
aldosterone, hyperaldosterone = hypernatremia, hypokalemia, metabolic alkalosis (H+ follows K+)
113
this rx blocks the effect of aldosterone
spironolactone
114
this nerve is compressed in carpal tunnel
median
115
anti-centromere, anti-nuclear, anti-topo Ab
CREST syndrome; scleroderma (fibrosis + vascular dysfunction; esophageal fibrosis, arthralgias, raynaud, ILD, renal crisis, heart issues, hardneing of skin)
116
MPC, PIP, wrist, cervical spine, axial skeleton, risk of subluxation with SC compression
RA
117
+ iron, ferriting, transferrin, HFE gene, tan, diabetes
hemachromatosis
118
hip pain worse with weight-bearing, nl XR, no point tenderness
worry about avascular necrosis
119
asymptomatic elevation of alk phosp
paget disease
120
rx that decreases Ca stones but increases gout events
Thiazides
121
anti-cardiolipin Ab
anti-phospholipid syndromes; recurrent SAB, hypercoagulabor state, falsely + VDLR
122
mouth to anus, transmural inflammation, fistulae, skip lesions
Crhon's disease
123
tx of aspiration pneumonia
azithromycin + clindamycin
124
low haptoglobin, high indirect bili, LDH and retic count
intravascular hemolytic anemia
125
how is extravascular hemolytic anemia different from intravascular
extravascular = normal labs
126
hemolytic anemia in 4th decade of life, cytopenia, hypercoagulable state, CD55 + CD 59
paroxysmal nocturnal hemo
127
causes of microcytic anemia
iron deficiency, hemoglobinopathy, lead toxicity, chronic disease
128
labs for iron deficiency anemia
low MCV, iron, and ferritin, HIGH TIBC
129
factor V unable to respond to protein C, thrombosis, hypercoagulation, AD
Factor V Leiden
130
myeloproliferative, JAK2, HCT > 50%, thrombosis, gout, pruritus, visual changes, HTN
polycythemia vera
131
acronym for MM
CRAB (calcium, renal failure, anemia, bone fractures)
132
B cell neoplasm, Reed Sternberg cells, mediastinal mass, LAD, cyclical fevers
Hodgkin Lymphoma
133
causes of vitamin B12 deficiency (macrocytic anemia)
vegan, gastritis, gastrectomy, low IF, pernicious anemia
134
white, northern european ancestery, atrophic glossitis, vitiligo, thyroid, neuro
pernicious anemaia
135
If B12 or folate is low, what would you expect homocysteine levels to be?
HIGH, because unable to convert to methionine
136
AD, NE European, defect in RBC membrane proteins so get rigid RBCs trapped in spleen, jaundice, pigment gallstones, acute cholecysitis
Hereditary Spherocytosis
137
ANCA, lower and upper respiratory, golumerulonephritis, otitis, sinusitis, hemoptysis, fatigue, wt loss
granumolatosis polyangiiitis
138
fatty casts
nephrotic
139
RBC casts
nephritis
140
3 step workup for seizure
check electrolytes, check urine, get imaging
141
this electrolyte disturbance can lead to - broad flat T waves, u waves, ST depression, afib, torsades
HYPOkalemia
